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PostPosted: Fri Mar 25, 2016 1:07 pm 
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Hello, this is my time posting though I've been a registered lurker for some time lol. I have been on Zubsolv for about 16 months I have been stable on 1 5.7mg dose per day and I have quite a bit of dental work that needs to be done, extractions, implants. I am very familiar with Dr. Junig's methods and suggestions of buprenorphine and surgical procedures, getting to 4mg a day and staying there while receiving other agonists for pain. My question is regarding Zubsolv and what mg I am actually on, I know that 5.7mg of Zubsolv is equal to 8mg of Suboxone due to it apparently having a more efficient bioavalibility. A few days ago in preparation for procedures I started to break my 5.7 Zubsolv dose in half so I am now taking 2.85 mg give or take once a day..I want my doctor/surgeon to know what amount of Bupe I am on so where I am confused is, am I on 2.85mg of Bupe or am I on 4 mg of Bupe since less zubsolv equals more suboxone? Am I making any sense with my question? I apologize because I am so confused with it myself. Thanks for any help!


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PostPosted: Fri Mar 25, 2016 2:00 pm 
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JJ,

No matter how low you get on Buprenorphine it will still block any other opiates from working unless they are given like Dr. Junig explained in his blog. I'm not saying to stop tapering, but don't get the impression that a pain pill will do any good unless it's in a higher dosage.

For addicts, we confuse pain pills working by judging how it affects our brain. It will have no effect on your sense of feeling it. That doesn't mean it isn't working to help dull the pain. In my mind I figured if I couldn't feel it it wasn't doing anything. Now I read differently. Do what our good doctor recommends and hope for the best.

With dental work, the best pain pill for me is Aleve, or Naproxen. Back when pain pills could be felt in my brain it didn't seem to do any good at all. What worked was an over the counter anti-inflammatory drug like Ibuprofen or Naproxen. Maybe even Excedrin would do the trick. Each person has their own favorite. I just swear by Aleve only because I've felt it work very quickly with both dental and neck pain. It's my wonder drug and I'm very grateful it's available w/o a script.

Let us know how it works out. Pain reduction while on Buprenorphine is always a hot topic.

Good luck finding relief,

rule

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PostPosted: Fri Mar 25, 2016 2:23 pm 
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Thanks for the reply, yes I know even 1 mg of Bupe will still have a blockade on the receptors it's just I'm unclear on zubsolv = Suboxone and since most doctors/surgeons aren't familiar with Suboxone I'm sure even more are unfamiliar with Zubsolv being it's fairly new. 5.7 zubsolv equal to 8mg suboxone, so if I'm taking half of a 5.7 zubsolv do I have 4mg bupe or half of 5.7 mg Bupe which roughly is 2.85mg in my system lol I guess that's where the real question and discussion is..at the end of the day the bottom line is I still have a Bupe blockade going on but for the doctors involved in any procedure I want them to know as best they can what amount of Bupe is in my system


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PostPosted: Fri Mar 25, 2016 3:21 pm 
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Hey Joshy.

While not on bup at the time, I had lots of dental surgery and implant work done w different oral surgeons.

My 2 cents is to ask what pain mgt will be used - local nerve blocks w or wo script opiates after? IV sedation w or wo local blocks w or wo script opiates after? IME, all of these scenarios are possible. Surprising to me -- 2 oral surgeons preferred Buprenorphine as their IV pain med during surgery, which would not help you.

My tips: I asked for additional marcain (longer acting) blocks, either at the end of the procedure or if procedure was done earlier in the day, I'd get a ride back late day for more blocks to keep me numb all night. Also, consider asking about oral steroids (prednisone) post-op. I had major dental surgery done w and wo and they caused a huge decrease in pain.

Frankly, I was already on such high levels of my DOC that the post-op opiate script did nothing to help. But, my 2 tips really helped me post op and made all go pretty well. Best, Pelican


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PostPosted: Sat Mar 26, 2016 1:16 am 
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Good luck with your dental implants. I had implants about 12 years ago. Post op pain was substantial for about two days. I got an rx for narcotics for post op pain and found that 2 pain pills plus motrin worked for pain. I don't know for sure, but assume that 4 mg of bupe means suboxone or generic equivalents since Zubsolv is so new.


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PostPosted: Sat Mar 26, 2016 1:42 am 
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Thank you all kindly for your replied and all wonderful suggestions, I do greatly appreciate each one of you who offers up their own advice going through something like this and I will take all of your advice. I do want to say, I know Dental Implants/Extractions is not back surgery, invasive heart surgery...but I tell you,I spent 8 hours in a dentist's chair in 2013 getting 4 root canals from 8am to 4pm, and I was on 8 mg of Suboxone and it was torture and due to me choosing to stay on the suboxone and deny all pain medication...well 2 hours later at 8 pm when I was coming to and all my nova/marcaine was wearing off....yes that was one instance in my life where it created the perfect storm of a relapse for Me because I was in such uncontrollable head pounding/mouth Mashing pain, there was no way the doctor was going to help me, so I had to do what I had to do and DR. JOSH myself out of that certain moment of hell, and nothing else mattered other than that awful pain,so basically I relapsed on street Strong Heroin because the doctor thought he knew best....excuse me BUT if my pain HAD BEEN kept comfortable like it should have been I would not AT ALL had to run off looking for street bullshit!

I apologize but I still feel so upset and so strongly about that time, I want to be taken seriously and I don't want to relapse again because some "Big head honcho Dr. "KNOWS BEST" when he really does not. I want to be treated and have every right to be treated with narcotic pain medication regardless if I am an addict or not, if I'm in pain just treat me not the addict in me because I'm obviously going back on Buprenorphine immediately after a few days after the procedure, ugh these control freaks


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PostPosted: Sat Mar 26, 2016 12:11 pm 
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Hey Joshy,

I understand! I hear you loud and clear. Its really important given what happened to you last time.

What I say is IME and IMO from years of successful facial/oral/dental surgery due to poor dental hygiene and an accident crushing my face. Its one of the reasons I grew into large fentanyl abuse. I've had body surgeries and oral surgeries and by far, the oral were much harder. So I hear you...

1. Get bup low as you can as early as you can. Yes, convert zub to sub as you are doing. But, will your surgeon even understand what a 4 mg sub level means? Yes, it will show that you have followed Dr Js protocol but more importantly, you will likely still need to push for the right amt of post-op meds.
2. Talk to your surgeon like you just did to us! Show a determined confidence, strength and knowledge.
3. Write down talking points. State what opiate med you need - dose, quantity, frequency. Get from Dr J's handout. Ask for a prednisone script, if its not already a part of post-op care. Makes a huge difference! Its more powerful than OTC anti-inflammatories.
4. Practice practice practice your talking points.
5. Ask, learn the pain mgt protocol. Know what meds are used during surgery. Don't assume is not bup. Some docs/patients like the shorter acting nerve blocks because mouth function returns faster. Not me, I liked the long blocks. And I went back for more at end of day. Both the med and location of blocks affect how long the block lasts.
6. After, keep your head truly elevated!! Do not let gravity pull more fluid into the mouth and make it worse! Swelling is the enemy. That's why anti-inflammatories (Prednisone, Aleve, Advil) are so helpful.
6. Know what all will be done. Not sure where in mouth you will get your implants and if you might have a bone graft or sinus lift done too? The more done the more likely you will need more meds post-op.

Good for you for being so protective of your clean time. NO you do not want to go bk out because of this and you do not need to!

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Did well on Suboxone. Stopped May 2011.
Stopping went well -- its the staying stopped -- where the real work begins.
Coming here 'keeps recovery green'.


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PostPosted: Sat Mar 26, 2016 4:21 pm 
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I will most certainly ask for the prednisone and most certainly don't ever want to go back out I wish at the time of my last mouth torture procedure I'd have known about this forum and dr. J's recommendation for pain management while on Bupe maybe would have made the difference. I've finally got my life back together at 35 after years of Hell I'm not going back out regardless of what happens, it becomes much more difficult to get your life back in order after relapses the older you get! I just find it difficult to advocate for myself being a recovering addict some doctors seem it strange when a patient knows alot about certain pain meds or requests certain things they see it as addict seeking behavior and I get it I don't blame them with all that's going on in the world and news today regarding prescription abuse and heroin deaths skyrocketing. As long as everyone is on the same page and my bupe doc is in contact with any other docs involved that's the important thing. Thanks for the advice and recommendations!


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Fond Du Lac Psychiatry
Dr. Jeffrey Junig, M.D., Ph.D.

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